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General NPI Number Information
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NPI Number | 1891340071
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Entity Type | Individual
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Provider Name | SEANIA FULTON
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Gender | Female
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Dates
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Enumeration Date | 08/05/2019
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Last Update Date | 08/05/2019
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Provider Practice Location Address
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Address Line | 212 S JONES BLVD
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City | LAS VEGAS
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State | NV
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Zip | 89107-2657
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Country | US
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Telephone | 702-639-1940
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Fax | 702-920-9404
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Provider Business Mailing Address
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Address Line | 1200 W CHEYENNE AVE APT 2094
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89030-7883
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Country | US
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Telephone | 702-772-6759
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Fax | 702-920-9404
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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